Chief Actuary, Jefferson Health Plans

Jefferson Health Plans • Philadelphia, PA

45d • Hybrid

About The Position

We are seeking a Chief Actuary to lead the actuarial strategy and execution across our government-sponsored health programs, including Medicaid, Medicare, CHIP, and ACA. This executive will serve as a key member of the leadership team, responsible for driving pricing strategy, reserving accuracy, and trend analytics that support sustainable growth and financial performance. The ideal candidate will bring deep technical expertise, a strong command of regulatory environments, and a collaborative leadership style to influence enterprise-wide decisions. This role also includes evaluating and optimizing the balance between internal actuarial capabilities and external consulting support, particularly for ACA and Medicare pricing functions.

Requirements

• Bachelor’s degree in actuarial science, mathematics, statistics, or related field (Master’s preferred.)
• FSA (Fellow of the Society of Actuaries) designation required.
• 10 + years of actuarial experience in health insurance, with significant leadership in government programs (Medicaid, Medicare, CHIP, ACA).
• Proficient in actuarial modeling software (e.g., SQL, SAS, R, Python, Excel, VBA).
• Experience in building or reviewing models related to pricing, reserving, and risk adjustment.
• Proven track record in pricing, reserving, and trend analysis.
• Strong understanding of regulatory frameworks and rate filing processes.
• Exceptional leadership, communication, and stakeholder management skills.
• Experience working in a matrixed or highly collaborative organizational structure.
• Strategic thinker with the ability to translate complex data into business insights.

Responsibilities

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Strategic Pricing Leadership Own and oversee pricing strategy and rate development for Medicare, and ACA products, ensuring competitiveness and compliance with regulatory requirements.
• Evaluate and rationalize the division of pricing responsibilities between internal actuarial teams and external consultants, particularly for ACA and Medicare lines of business.
• Develop a roadmap to transition appropriate pricing functions in-house where it adds strategic value, enhances agility, or improves cost-efficiency, while maintaining strong oversight of consultant-delivered work.
• Ensure pricing methodologies are actuarially sound, data-driven, and aligned with both regulatory expectations and enterprise financial goals.
• Reserving and Forecasting Lead the development of actuarial reserves and financial forecasts, ensuring accuracy, transparency, and alignment with corporate financial goals.
• Trend analysis and insights Analyze medical cost trends and utilization patterns to inform business strategy, product design, and cost containment initiatives.
• Cross Functional Collaboration Partner with Finance, Clinical, Product, and Regulatory teams to translate actuarial insights into actionable business strategies.
• Regulatory Engagement Serve as the actuarial point of contact for state and federal regulators, ensuring timely and accurate submissions and responses.
• Team Leadership and Development Build, lead, and mentor a high-performing actuarial team, with a focus on recruiting top talent and expanding internal capabilities.
• Foster a culture of innovation, accountability, and continuous improvement to support the organization’s long-term growth and self-sufficiency.
• Data driven decision making Champion the use of advanced analytics and predictive modeling to enhance pricing accuracy and operational efficiency.
• Strategic Pricing Leadership Own and oversee pricing strategy and rate development for Medicare, and ACA products, ensuring competitiveness and compliance with regulatory requirements.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Number of Employees: 501-1,000 employees